AB1277 FACTORS ASSOCIATED WITH THE PRESENCE OF SPINAL EPIDURAL ABSCESS IN SPONDYLODISCITIS
Authors: M. Ghali, M. Ardhaoui, J. Mahbouba, S. Zrour, I. Bejia, M. Touzi, N. Bergaoui
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondylodiscitis (SD) is a severe infectious disease that affects the intervertebral disc and adjacent vertebral bodies, but may also extend to adjacent neural structures and cause a spinal epidural abscess (SEA). The clinical picture of SD is not very specific, but there are clinical and radiological differences that may point to an epidural extension. <h3>Objectives</h3> This study aimed to compare the clinical, biological, and radiological features of spondylodiscitis (SD) with and without spinal epidural abscess (SEA). <h3>Methods</h3> We conducted a retrospective monocentric study involving 90 cases of SD admitted between January 2009 and August 2022 at our rheumatology department. Clinical, laboratory, and radiological data of the patients were collected. <h3>Results</h3> Among the 90 patients with SD, 54 (60%) had a spinal epidural abscess. The mean age of the SEA group was 54 ± 13.52 years [23-82]. A female predominance was observed with a sex ratio (M/F) of 0.92. Thirty-seven patients or 68.5% had at least one comorbidity. Diabetes was the most frequent comorbidity (33.3%). All our patients had back pain on admission. Motor deficits were reported in 48% of the patients with the heaviness of the limbs. Fever was reported in 46.3% of cases. Physical examination revealed spinal stiffness in 23.3% of the patients, motor deficit in 37%, sharp osteotendinous reflexes in 18.5% of the patients, and abolished in 9.25%. The blood tests showed hyperleukocytosis in 18 patients (36%). An erythrocyte sedimentation rate greater (ESR) than 100 mm at the first hour was found in 17 patients. C-reactive protein (CRP) greater than 100 mg/ml was found in 14 patients. 64.8% had pyogenic spondylodiscitis (mainly Staphylococcus aureus), 11.1% had brucella spondylodiscitis and 24.1% had tubercular spondylodiscitis. MRI confirmed the diagnosis of SEA in all cases. The lesions were located at the cervical level in 9.2% of cases, at the dorsal level in 24 %, and at the lumbar level in 48.1% of cases. The lesions were anterior in 64.8% of cases and anterolateral in 35.2% of cases. The involvement was uni-focal in 63% of cases and extensive in 37% of cases. SEA was significantly more frequent in elderly patients (51.4% vs 48.6% p=0.038). The presence of a neurological deficit (80% vs 20% p=0.016), spinal cord compression (71.4% vs 28.6% p=0.04), and Multifocal involvement (82.6% vs 17.4% p=0.01) were significantly associated with SEA. There was no significant association between the types of germs and the presence of SEA. <h3>Conclusion</h3> In our study, a little more than half of patients with spondylodiscitis had a spinal epidural abscess. This entity was associated with advanced age, multifocal involvement, and neurological deficit. Therefore, a high index of suspicion is warranted when a patient presents these signs. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.